A Multicenter Survey of Acute Stroke Imaging Protocols for Endovascular Thrombectomy

Purpose: Identifying current practices in acute stroke imaging is essential for establishing optimal imaging protocols. We surveyed and assessed the current status of acute stroke imaging for endovascular thrombectomy (EVT) at tertiary hospitals throughout South Korea.Materials and Methods: An electronic questionnaire on imaging protocols for EVT in patients with acute ischemic stroke was e-mailed to physicians at 42 registered tertiary hospitals, and their responses were collected between February and March 2020.Results: Of the 36 hospitals participating in the survey, 69% (25/36) adopted computed tomography (CT)-based protocols, whereas 31% (11/36) adopted magnetic resonance (MR)-based protocols. Non-enhanced CT (NECT) was the initial imaging study at 28%, NECT with CT angiography (CTA) at 36%, and NECT with CTA and CT perfusion (CTP) at 33% of hospitals. Perfusion imaging was performed at 61% (22/36), CTP at 44% (16/36), and MR perfusion at 17% (6/36) of hospitals. Multiphase CTA was performed at 67%, single-phase CTA at 11%, time-of-flight MR angiography (MRA) at 8%, contrast-enhanced MRA at 8%, and both at 6% of hospitals. For late time window stroke, 50% of hospitals used identical imaging protocols to those for early time window stroke, 39% used additional MR imaging (MRI), and 6% converted the imaging strategy from CT to MRI. Post-processing programs were used at 28% (10/36), and RAPID software at 14% (5/36) of hospitals, respectively. Most hospitals (92%) used the same imaging protocols for posterior and anterior circulation strokes.Conclusion: Our multicenter survey demonstrated considerable heterogeneity in acute stroke imaging protocols across South Korean tertiary hospitals, suggesting that hospitals refine their imaging protocols according to hospital-specific conditions.

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Acute Stroke Imaging Research Roadmap IV: Imaging Selection and Outcomes in Acute Stroke Clinical Trials and Practice

Stroke ◽

10.1161/strokeaha.121.035132 ◽

2021 ◽

Author(s):

Bruce C.V. Campbell ◽

Maarten G. Lansberg ◽

Joseph P. Broderick ◽

Colin P. Derdeyn ◽

Pooja Khatri ◽

...

Keyword(s):

Clinical Trials ◽

Acute Stroke ◽

Time Window ◽

Stroke Treatment ◽

Consensus Recommendations ◽

Stroke Imaging ◽

The Us ◽

Imaging Research ◽

Optimal Imaging ◽

Acute Stroke Imaging

Background and Purpose: The Stroke Treatment Academic Industry Roundtable (STAIR) sponsored an imaging session and workshop during the Stroke Treatment Academic Industry Roundtable XI via webinar on October 1 to 2, 2020, to develop consensus recommendations, particularly regarding optimal imaging at primary stroke centers. Methods: This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss imaging priorities in the light of developments in reperfusion therapies, particularly in an extended time window, and reinvigorated interest in brain cytoprotection trials. Results: The imaging session summarized and compared the imaging components of recent acute stroke trials and debated the optimal imaging strategy at primary stroke centers. The imaging workshop developed consensus recommendations for optimizing the acquisition, analysis, and interpretation of computed tomography and magnetic resonance acute stroke imaging, and also recommendations on imaging strategies for primary stroke centers. Conclusions: Recent positive acute stroke clinical trials have extended the treatment window for reperfusion therapies using imaging selection. Achieving rapid and high-quality stroke imaging is therefore critical at both primary and comprehensive stroke centers. Recommendations for enhancing stroke imaging research are provided.

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Procedural Complications During Early Versus Late Endovascular Treatment in Acute Stroke

Stroke ◽

10.1161/strokeaha.120.031349 ◽

2021 ◽

Author(s):

Errikos Maslias ◽

Stefania Nannoni ◽

Federico Ricciardi ◽

Bruno Bartolini ◽

Davide Strambo ◽

...

Keyword(s):

Endovascular Treatment ◽

Acute Stroke ◽

Time Window ◽

National Institutes Of Health ◽

Late Time ◽

Short Term ◽

Term Outcome ◽

Stroke Registry ◽

Short Term Outcome ◽

Procedural Complications

Background and Purpose: Endovascular treatment (EVT) in acute ischemic stroke is effective in the late time window in selected patients. However, the frequency and clinical impact of procedural complications in the early versus late time window has received little attention. Methods: We retrospectively studied all acute ischemic strokes from 2015 to 2019 receiving EVT in the Acute Stroke Registry and Analysis of Lausanne. We compared the procedural EVT complications in the early (<6 hours) versus late (6–24 hours) window and correlated them with short-term clinical outcome. Results: Among 695 acute ischemic strokes receiving EVT (of which 202 were in the late window), 113 (16.3%) had at least one procedural complication. The frequency of each single, and for overall procedural complications was similar for early versus late EVT (16.2% versus 16.3%, P adj =0.90). Procedural complications lead to a significantly less favorable short-term outcome, reflected by the absence of National Institutes of Health Stroke Scale improvement in late EVT (delta-National Institutes of Health Stroke Scale-24 hours, −2.5 versus 2, P adj =0.01). Conclusions: In this retrospective analysis of consecutive EVT, the frequency of procedural complications was similar for early and late EVT patients but very short-term outcome seemed less favorable in late EVT patients with complications.

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Mobile Interventional Stroke Teams Improve Outcomes in the Early Time Window for Large Vessel Occlusion Stroke

Stroke ◽

10.1161/strokeaha.121.034222 ◽

2021 ◽

Author(s):

Jacob R. Morey ◽

Xiangnan Zhang ◽

Naoum Fares Marayati ◽

Stavros Matsoukas ◽

Emily Fiano ◽

...

Keyword(s):

Scale Score ◽

Time Window ◽

Early Time ◽

National Institutes Of Health ◽

Large Vessel ◽

Late Time ◽

Modified Rankin Scale ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Endovascular Thrombectomy

Background and Purpose: Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge outcomes, as compared with the drip-and-ship (DS) model. The effect of the MIST model stratified by time of presentation has yet to be studied. We hypothesize that patients who present in the early window (last known well of ≤6 hours) will have better clinical outcomes in the MIST model. Methods: The NYC MIST Trial and a prospectively collected stroke database were assessed for patients undergoing endovascular thrombectomy from January 2017 to February 2020. Patients presenting in early and late time windows were analyzed separately. The primary end point was the proportion with a good outcome (modified Rankin Scale score of 0–2) at 90 days. Secondary end points included discharge National Institutes of Health Stroke Scale and modified Rankin Scale. Results: Among 561 cases, 226 patients fit inclusion criteria and were categorized into MIST and DS cohorts. Exclusion criteria included a baseline modified Rankin Scale score of >2, inpatient status, or fluctuating exams. In the early window, 54% (40/74) had a good 90-day outcome in the MIST model, as compared with 28% (24/86) in the DS model ( P <0.01). In the late window, outcomes were similar (35% versus 41%; P =0.77). The median National Institutes of Health Stroke Scale at discharge was 5.0 and 12.0 in the early window ( P <0.01) and 5.0 and 11.0 in the late window ( P =0.11) in the MIST and DS models, respectively. The early window discharge modified Rankin Scale was significantly better in the MIST model ( P <0.01) and similar in the late window ( P =0.41). Conclusions: The MIST model in the early time window results in better 90-day outcomes compared with the DS model. This may be due to the MIST capturing high-risk fast progressors at an earlier time point. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03048292.

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Acute Stroke Imaging Research Roadmap

Stroke ◽

10.1161/strokeaha.107.512319 ◽

2008 ◽

Vol 39 (5) ◽

pp. 1621-1628 ◽

Cited By ~ 169

Author(s):

Max Wintermark ◽

Gregory W. Albers ◽

Andrei V. Alexandrov ◽

Jeffry R. Alger ◽

Roland Bammer ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Imaging ◽

Imaging Research ◽

Acute Stroke Imaging

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The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽

10.1371/journal.pone.0113967 ◽

2014 ◽

Vol 9 (12) ◽

pp. e113967

Author(s):

Yuanqi Zhao ◽

Min Zhao ◽

Xiaomin Li ◽

Xiancong Ma ◽

Qinghao Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Predictive Value ◽

Chinese Population ◽

Stroke Patients ◽

Stroke Imaging ◽

Acute Stroke Imaging

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Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System

American Journal of Neuroradiology ◽

10.3174/ajnr.a1441 ◽

2009 ◽

Vol 30 (4) ◽

pp. 703-709 ◽

Cited By ~ 28

Author(s):

L.E. Cipriano ◽

M.L. Steinberg ◽

G.S. Gazelle ◽

R.G. González

Keyword(s):

Acute Stroke ◽

Classification System ◽

Minor Stroke ◽

Stroke Imaging ◽

Acute Stroke Imaging

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Neuroimaging of Acute Stroke

10.1093/med/9780199937837.003.0102 ◽

2017 ◽

Author(s):

Chelsea S. Kidwell ◽

Kambiz Nael

Keyword(s):

Acute Stroke ◽

Resonance Imaging ◽

Significant Progress ◽

Stroke Patients ◽

The Past ◽

Stroke Imaging ◽

Magnetic Resonance Imaging Mri ◽

Noncontrast Computed Tomography ◽

Acute Stroke Imaging ◽

Multimodal Ct

The neuroimaging workup for patients with suspected acute ischemic stroke has advanced significantly over the past few decades. Evaluation is no longer limited to noncontrast computed tomography (CT), but now frequently also includes vascular and perfusion imaging. Although acute stroke imaging has made significant progress with the development of multimodal approaches, there are still many unanswered questions regarding their appropriate use in daily patient care. It is important for all physicians taking care of stroke patients to be familiar with current multimodal CT and magnetic resonance imaging (MRI) techniques, including their strengths, limitations, and their role in guiding therapy.

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